Gombe State Framework for the Implementation of Expanded Access to Family Planning Services 2013-2018 December 2012 December 2012 Gombe State Framework for the Implementation of Expanded Access to Family Planning Services 2013-2018 December 2012 The Gombe State Framework for the Implementation of Expanded Access to Family Planning Services 2013 2018 was developed by the Gombe State Ministry of Health in July 2012. Financial Assistance for the framework was provided by the U.S. Agency for International Development (USAID) under the terms of the‒ Cooperative Agreement GPO – A-00-08-00001-00 through FHI 360’s Program Research for Strengthening Services (PROGRESS) project. The contents of this publication do not necessarily reflect the views of USAID or the U.S. government. This publication may be freely reviewed, quoted, reproduced or translated, in full or in part, provided the source is acknowledged. ©2012 Gombe State Ministry of Health, Nigeria First published in 2012 by the Gombe State Ministry of Health, Nigeria, with support from USAID– PROGRESS Citation: Gombe State Ministry of Health (SMoH). 2012. Gombe state framework for the implementation of expanded access to family planning services. Gombe (Nigeria): SMoH; 2012 Dec. TABLE OF CONTENTS LE OF CONTENTS Table of contents ................................................................................................................................... 1 Foreword ................................................................................................................................................ 3 Acknowledgements ................................................................................................................................ 4 Acronyms ............................................................................................................................................... 5 Executive Summary ............................................................................................................................... 7 Introduction ........................................................................................................................................... 9 1.1 Family Planning in Nigeria .................................................................................................... 9 1.2 Family Planning in Gombe State ..........................................................................................10 1.3 Rationale for Expanding Community and Facility-based FP Service Delivery .................... 11 Methodology for Creating the Implementation Framework ................................................................ 13 Goals, Objectives and Strategic Intervention Areas ............................................................................. 15 3.1 Goal ........................................................................................................................................15 3.2 Objectives and Targets ..........................................................................................................16 3.3 Eight Strategic Intervention Areas ........................................................................................18 3.4 Benefits and Impact of Expanded Family Planning Service Delivery ..................................... 20 Plan of Action........................................................................................................................................21 4.1 Objective 1 .............................................................................................................................21 4.2 Objective 2 .............................................................................................................................31 4.3 Objective 3 ............................................................................................................................ 38 4.4 Objective 4 ............................................................................................................................ 43 Budget Summary ................................................................................................................................. 46 Appendix 1. Calculation Justifications and Assumptions ................................................................... 47 Appendix 2. Summary of Stakeholder Analysis ................................................................................... 53 Appendix 3. Participation List: CBA TWG Meeting Convened September 21 22, 2011, on the Road Map for Scaling Up Community-Based Access to Family Planning Focused on Injectables in Nigeria ................................................................................................................................‒ ............. 56 Appendix 4. Participation List: Planning Meeting Convened July 18 20, 2012, on the Gombe State Framework for the Implementation of Expanded Access to Family Planning Services Framework ‒ 2013 2018 .............................................................................................................................................. 58 Appendix‒ 5. Participation List: Review Meeting held October 4, 2012, on the Gombe State Framework for the Implementation of Expanded Access to Family Planning Services Framework 2013 2018 .............................................................................................................................................. 59 Appendix‒ 6. WHO Health System Framework .................................................................................... 61 References ............................................................................................................................................ 62 Other Resources................................................................................................................................... 63 1 Tables and Figures Figure 1: Trends in unmet family planning needs by area of residence: 1990, 1999, 2003 and 2008 ..... 9 Figure 2: Trends in modern contraceptive prevalence in Nigeria by zone: 1999, 2003 and 2008 ........ 10 Figure 3: Distribution of health personnel working in Gombe state by cadre ..................................... 11 Figure 4: Goals, objectives and strategic areas of intervention ............................................................ 15 Table 1: Annual Progression towards Targets by Objective ................................................................. 17 Table 2: Family Planning Impact Indicators....................................................................................... 20 Table A1.1. Number of Health Personnel Providing FP and Training in FP ..................................... 47 Table A1.2. Clinicians Required by Base Year .................................................................................... 48 Table A1.3. Number of Wards with Access to CBFP and Health Facilities Providing FP ................. 48 Table A1.4. Requirements to Reach CPR Goal — Number of FP Users, Number of Commodities, Cost for Commodities and Logistics, Percent of Users by Method ........................... 49 Table A1.5. Commodity Costs (US$) ....................................................................................................51 Table A1.6. FP Support by Men, Women, Youth, Community Leaders and Policymakers ................. 51 Table A1.7. Family Planning Impact Indicators.................................................................................. 52 2 FOREWORD Family planning saves lives. Family planning prevents up to one third of maternal deaths and can reduce child mortality. In many states in Nigeria, including Gombe state, many women still die from childbirth. Infant and child mortality rates remain high. Most women have an average of seven children in their lifetime while the use of family planning services remains low. The shortage of skilled health care workers and a weak distribution chain have contributed to limited access to family planning services in rural areas. To address these challenges, the Gombe state government developed the Gombe State Framework for the Implementation of Expanded Access to Family Planning Services 2013–2018. This framework builds on previous family planning efforts in Gombe state, particularly the 2008–2010 community-based access to injectable contraceptives pilot implemented in two local government areas. The pilot, implemented by the Association of Reproductive and Family Health (ARFH) and FHI 360 (formerly Family Health International), with funding from the U.S. Agency for International Development (USAID), demonstrated that community health extension workers could safely provide injectable contraceptives at the community level. This pilot provided the evidence for policy change. The framework will ensure universal access to modern family planning methods across the state. This expansion framework identifies an overarching family planning goal, objectives, strategic intervention areas and key activities required to guide the scale-up of quality family planning services by all cadres of health workers at all service delivery levels across Gombe state. This framework’s success will depend on commitments made and fulfilled by relevant stakeholders, including the federal government, Gombe state government, donors, implementing partners, civil society nongovernmental organizations, religious and traditional leaders, the private sector and the citizens of Gombe state. Stakeholders will play a role in funding, organizing, managing